By Eric Fishman, MD

Should you Purchase Dragon Medical Before, During or After an EMR Implementation?

We are frequently asked the question “If a physician is going to eventually use Dragon Medical with an EMR, is it preferable to purchase Dragon before, during or after the EMR is acquired?”.

Fortunately, there is no one right answer to this question, just as when operating I found that ‘one size fits none’ was an appropriate expression when it came to gloves in the operating room. In other words, it is necessary to determine your particular workflow, operating environment and goals, and to then make a decision. Hopefully, the parameters discussed below will allow you to make a more educated decision about this issue.

Having said that, please understand that the parent company of EMRConsultant is 1450, Inc., the county’s largest distributor of Dragon Medical. This provides us with both a substantial amount of information from which to draw conclusions, as well as a vested interest in encouraging you to utilize Dragon Medical in your office. We thought that you should understand both of those inclinations of ours from the beginning.

Now, let’s make an assumption that in the not too distant future you will, in fact, be using a state of the art EMR, and whether it is a client/server or ASP (SaaS) EMR is a decision which is rather tangential to this question. I bring that up because Dragon will work very well in both of those environments.

From the federal government down, there has been a significant push to ensure that essentially all physicians adopt an EMR by 2014, but in reality, I believe that there are a number of compelling reasons to acquire this technology significantly earlier than this self-imposed deadline provided by governmental entities. Furthermore, let’s make a reasonable assumption that you, like most physicians who do utilize EMRs will find them to be more palatable when used with a speech recognition software system such as Dragon Medical. To support this, it has been found that physician adoption of EMRs is substantially enhanced by the proper utilization of speech recognition technology.

The purpose of this paper is to provide some guidance concerning the respective timing of the acquisition of Dragon Medical and the EMR software. As you will see, there are advantages and disadvantages to each of the 3 possible scenarios.

Advantages of Purchasing Dragon Medical Before an EMR

There are some rather compelling reasons to acquire Dragon Medical prior to starting to use your EMR.

First, let’s dispel a potential obstacle which is that Dragon will end up either being incompatible with or not necessary with your chosen EMR. While the possibility does exist that you will end up purchasing or otherwise acquiring a strictly MAC compatible EMR, the probability of this being the case is extremely low. Personally, I happen to like Apple products. However, their penetration of the EMR market is, at this time, unfortunately extremely low, and therefore the probability of your soon to be chosen EMR being incompatible with Dragon is also extremely low. I guess I need to explain this by stating, rather straightforwardly, that if you are going to use a Windows compatible EMR, that there is an overwhelmingly high probability that it will be to some extent or another, and probably to a great extent, very compatible with Dragon Medical. This is not to state that there will be no integration issues whatsoever. However, this potential to have minor integration issues is in fact one of the more compelling reasons to acquire Dragon early in the process of automating your office – namely that by the time you do acquire an EMR, you will have enough familiarity with Dragon to be able to assist with the integration yourself, thereby minimizing the significant workflow disruptions that are going to inevitably occur with implementation of an EMR. While we’ve acknowledged that the majority of EMRs work very well with Dragon, if you try hard enough it is possible to find one that doesn’t work as well as you would want it to, in a Dragon environment. We can’t overstate the emphasis we give to having a complete system which includes an EMR and speech recognition software. If you acquire Dragon first, you will try to use any prospective EMR with Dragon, and you will thereby minimize the potential of acquiring an EMR that is not adequately compatible with Dragon.

Other compelling reasons for implementing Dragon first exist. For instance, it is rather self-evident that there is a phenomenal ROI (return on investment) when a practice begins dictating and transcribing their notes using Dragon Medical. The ROI begins essentially immediately, and there really are no compelling reasons to delay taking advantage of the monetary savings afforded by using Dragon. Since it is clear that there is a much wider variety of choices when it comes to EMR technology, and that the best choice is not always self-evident, there are frequently substantial delays both in choosing and implementing an EMR. These delays are frequently many months, and not infrequently can be a year or more in large institutions. Since Dragon Medical usually pays for itself in significantly less than 6 months (unless you are currently handwriting your notes, in which case the payback is quality of care more than monetary), it is rather common that if you acquire Dragon when you start your EMR search, that you will have already paid for the Dragon component in full with your transcription savings by the time you purchase the EMR.

Another advantage of purchasing and using Dragon Medical before implementing an EMR may be considered to be psychological. Implementing an EMRs is a major event in one’s life. For those of us who are not particularly sophisticated when it comes to computers, getting ready for the big plunge by learning a new computer skill can significantly increase your readiness for the substantially more involved process of learning an EMR. In essence you are sowing fertile ground by learning a new, but relatively less complicated yet still related computer skill, readying you for the task of learning an EMR.

There are still other advantages of learning Dragon first. I will take it as a given that at the end of the process you will be using Dragon and an EMR together, since that is, overwhelmingly, the most logical choice of technology to run your medical office and produce your medical records. Having said that, there are significant customization steps that are required for essentially every EMR in every specific medical office. It is best to undertake those customization steps once, rather than twice. Therefore, if you do not use Dragon first, and customize the workflow, templates and macros within the EMR to a non-Dragon enabled methodology, you will need to redo many of those customizations when you do implement Dragon. Thus, learning and using Dragon first will allow you to make one set of customizations to the EMR, rather than 2 sets. This is also true if you implement Dragon at the same time as the EMR, but to a significantly lesser extent.

Dragon is easy to learn, but a bit of attention must be paid to the effort. If it is done prior to the EMR training, the Dragon training will be maximized and you will have the best possible experience with Dragon, both with and without the EMR.

A more subtle reason for leading with Dragon is that many physicians are likely to have a generalized disbelief that technology will be able to assist them in running their office. However the ease with which a physician should be able to be trained in the use of Dragon, and the ease of creating documents, immediately, just by voice, is likely to increase their enthusiasm for the use of even more sophisticated EMR technology.

Finally, learning some of the basic macro features of Dragon Medical may increase a physician’s ability to intuitively understand how some of these features can be utilized within an EMR.

Disadvantages of Purchasing Dragon Medical Before an EMR

If you have a limited amount of time during which you will want to learn all of the technology, purchasing Dragon first may prolong the total learning time. This is most appropriate as a consideration in situations such as during the opening of a new office, in which you may wish to have all of your technology available to you simultaneously.

Learning various macros that will be utilized within MS Word, but not within a new EMR can be considered an extra step on the way to a combined system.

Also, it is conceivable that the hardware requirements of the EMR and Dragon will be meaningfully different, and when you purchase hardware for Dragon you may end up with hardware that is not perfect for the EMR. This is unlikely, particularly since Dragon is admittedly a very resource intensive program. However, you may find the need to add additional RAM into a CPU, for instance, when starting to use an EMR.

Advantages of Purchasing Dragon Medical at the Same Time as an EMR

The major advantage of purchasing both Dragon Medical and an EMR together is the streamlined process of implementation which can occur in this instance. The most classic example of this is when a physician is starting a new office. In that case, implementing both technologies simultaneously can be advantageous.

Another advantage of acquiring both of them together is that the total number of weeks during implementation may be minimized. I don’t believe that the total number of hours is likely to be diminished, but the number of calendar days between starting and finishing may be lessened by one or two.

There are workflow changes that are required whenever the method of charting is changed. When you implement Dragon and an EMR simultaneously, there is only one set of workflow changes which are needed, rather than a series of changes.

Finally, while the financial differences may be rather trivial, in part because of the disproportionate cost of Dragon in comparison to the cost of most EMRs, there is sometimes a modest discount available when purchased simultaneously.

Disadvantages of Purchasing Dragon Medical at the Same Time as an EMR

Learning the new workflow and technology of an EMR is an extraordinarily complicated task. The stories of 3 month implementations in small offices, and multi-year implementations in enterprise situations is not an exaggeration. The efforts can well be worth it, but it can be, and in fact in most instances is quite disruptive. Adding to this disruption with an additional task, no matter how trivial, can lead to more of an overwhelming sense of frustration.

Another disadvantage can be cash flow. The cost of Dragon Medical and all associated training is rather trivial in comparison to the cost of most EMR systems. However, when added to the cost of the system the timing can be unfortunate.

Advantages of Purchasing Dragon Medical after an EMR

The physician will understand exactly where within the EMR, and where within their daily workflow their use of Dragon will be helpful, and they can restrict their usage to exactly those specific locations, thereby, possibly, avoiding learning certain features of Dragon that might not be required of them in their daily workflow.

Disadvantages of Purchasing Dragon Medical after an EMR

First, and most obviously, all of the advantages of purchasing Dragon before or during the EMR implementation are lost if you purchase it after the fact. Possibly non-obvious disadvantages also include that the Dragon training, which is in fact the easiest part of learning a Dragon enabled EMR system, will be given less attention, and the user may never become as adept at using Dragon and the combined system as they otherwise would.

By Eric Fishman, MD. © 2009. All Rights Reserved